AAP Violence Prevention Program May Find Community Home

Action Points

Explain to interested patients that this study explored the feasibility and appropriateness and not the effectiveness of introducing the Connected Kids program into Head Start centers.

A violence prevention program that includes general parenting advice appears to be a good fit for community centers serving preschool-age children, researchers found.

The program -- dubbed Connected Kids: Safe, Strong, Secure -- was developed by the American Academy of Pediatrics and covers topics ranging from general parenting and discipline to bullying and teenage suicide. It was designed to be implemented in the clinic.

However, focus groups conducted at two Head Start centers indicated that the program would be well accepted and useful if implemented in a community setting, according to John Cowden, MD, of Children's Mercy Hospital in Kansas City, Mo., and colleagues.

"Although modiﬁcations might improve its usefulness, the curriculum seems acceptable and appropriate for the Head Start environment," they wrote online in Pediatrics.

Head Start is a 34-year-old federal program designed to promote school readiness in low-income children by providing a variety of educational, social, and nutritional services. Typically, youngsters attend preschool classes, while parents get advice from family advocates.

Connected Kids was designed to address 21 violence-related topics in children as old as 17. The AAP envisioned pediatricians taking the lead in implementation, but time constraints could make this difficult, the authors noted.

So Cowden and colleagues set out to assess whether implementing the program in a community setting would be appropriate.

They assembled focus groups involving parents and family advocates at two Head Start centers in the Kansas City metropolitan area -- one in an urban, predominantly minority community and one in a exurban, predominantly white community.

The researchers recorded eight 90-minute sessions and analyzed the discussions to elicit major themes.

Because Head Start centers focus on preschoolers, only the eight topics geared toward younger children were presented. These included an introduction to parenting, parenting tips for infants, a discussion of how infants learn, how to reduce the risk of gun injury, discipline, the importance of play in learning, TV violence, and interpersonal issues.

A total of 63 adults took part in the groups -- 38 family advocates (92% female) and 25 parents (100% female).

Overall, both sets of participants agreed that Head Start was an important source of parenting advice and a vital link to community resources.

Three of the topics -- parenting tips for infants, discipline, and TV violence -- were identified as particularly important in this setting.

The brochures presented were generally well liked, particularly because they included local information.

The family advocates raised concerns about the discussions of TV violence because they said many parents do not consider it to be a problem.

Parents questioned whether the advocacy of discipline based on so-called "time-outs" was the most effective method, although they were generally open to hearing about new ideas.

Gun safety showed a cultural divide. Urban mothers were more worried about guns in the community, not in the home.

Suburban and rural mothers, on the other hand, were somewhat turned off by the suggestion that the safest home was one without a gun. They sought more suggestions about safely securing weapons in the home.

Across the focus groups, participants requested varied means of transmitting information, particularly when brochures are likely to be unread and discarded. Suggestions included CDs, videos, guest speakers, a Web site, and role playing.

There was wide agreement that simply handing out materials would not be effective, the researchers said.

They acknowledged that even though Connected Kids appeared to be well accepted in the Head Start environment, funding would be an obstacle for implementation, and an external source would likely be needed.

They added that the study was limited by the use of only two centers in a single metropolitan area, the inclusion of early childhood topics only, the lack of male participants, and possible selection bias.

"The next step in this work is to collect pilot data from a selection of centers by using Connected Kids with parents, so that a curriculum addition speciﬁc to Head Start can be created, with provider training materials and other curriculum adaptations," they said.

A major challenge, they said, to assessing the program's efficacy will be to identify appropriate outcome measures.

The study was supported by a Resident CATCH grant from the American Academy of Pediatrics.

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